Alveolar Osteitis “Dry Socket” Prevention
Many exodontists ardently adhere to their method of prevention and treatment of AO without any sound scientific data to base their rationale upon. This is unfortunate, but most likely due to the paucity of well-controlled double blind studies in the occurrence, prevention, and treatment of AO.
One method, which has been scientifically proven to decrease the likelihood of AO, is pre-operative oral rinse with chlorhexidine .12% (Peridex, Proctor & Gamble Co., Cincinnati, OH). Immediate pre-operative oral rinse with Peridex has been clinically proven to decrease the quantity of oral microbes involved in AO.
Another scientifically proven method to decrease the likelihood of alveolar osteitis is the delivery of Lincomycin in an absorbable gelatine sponge to the immediate post-extraction site.
Many other methods to decrease the likelihood of AO have been discussed in the literature. These include topical and systemic antibiotic or steroids, placement of absorbable material in the extraction site with and without antibiotics and/or antifibrinolytic agents, or various combinations of the above. No method has proved superior to any other.
Despite the unknown etiology and the ambiguous contributing factors of AO, its clinical presentation is well known to all practitioners of dental exodontia. Patients typically present to the practitioner with intractable pain three to five days after extraction. Halitosis may or may not be present. Typical infection hallmarks, i.e., fever, malaise, pus, are absent. Examination of the surgical wound may or may not reveal erythema. The wound is usually tender to palpation. Rinsing out of the wound is typically quite painful, and often yields debris of food and dead tissue.
Treatment of the patient with AO or suspected AO is simple. After thorough irrigation of the site, a medicated sedative dressing, usually containing eugenol and oil of cloves, is placed in the extraction site. This is often quite uncomfortable to the patients initially, but relief soon follows within the hour. Systemic analgesics are often prescribed, but rarely necessary. Prescription of a systemic antibiotic is unnecessary. The patient is re-appointed to return to the office in 24 hours time for irrigation of the surgical site and change of the packing. Appropriate relief of symptoms usually takes two to four appointments. The patient should be encouraged to discontinue all tobacco products during this time.
If after four such appointments the patient’s condition has not improved, careful re-evaluation of the patient and the wound is necessary. The patient may be suffering from a subperiosteal infection, foreign body reaction, damage to the adjacent teeth, or even a fractured jaw. All these conditions may present similar to AO, but the treatment would, of course, be different.
Irrigation of the extraction site with an antimicrobial solution, such as Peridex, is desirable, but hardly a pre-requisite for success. Although an antimicrobial solution acts locally to decrease the number of microorganisms in the wound, and therefore decrease the local bacteria count, the primary reason to irrigate the wound is to remove any debris. Remember, the solution to pollution is dilution.
Placement of a medicated pack serves to deliver local analgesia to a healing wound. Since packs may spontaneously dislodge or be difficult to remove, use of a radiopaque material is recommended.
In summary, every surgeon should employ all reasonable efforts to decrease the likelihood of any complication in his patient. Although AO is a relatively minor post-operative complication, it does result in significant patient discomfort, and loss of productivity by both the patient and doctor. As practitioners of exodontia, we should strive to decrease the incidence of AO on all our patients. This includes the use of scientifically proven methods, i.e. pre-operative rinse of Peridex and use of local antibiotics, to decrease the incidence of AO. Anecdotal methods commonly employed and passed on from one dental practitioner to the next have merit; yet, should be carefully and scientifically evaluated with respect to their efficacy in treatment of Alveolar Osteistis.